Although levodopa remains mainstay of Parkinson's, physicians will increasingly use other agents to delay need for the drug, says DR

While levodopa remains the gold standard for Parkinson's disease treatment, physicians say they will increasingly use other agents to delay the need for levodopa. According to the new report from advisory firm Decision Resources, entitled Treatment Algorithms in Parkinson's Disease, 46% of surveyed neurologists say it is "very likely" or "likely" they will increasingly delay their use of levodopa-carbidopa in treatment practice over the next two years. In the USA, levodopa and carbidopa are prescribed together.

Physicians are looking to delay levodopa use because, over time, treatment with the drug can lead to motor fluctuations, dyskinesia and reduced responsiveness to levodopa. Compared with primary care physicians, surveyed neurologists less frequently use levodopa as first-line therapy for patients with mild disease under the age of 65 and are increasingly using dopamine agonists and MAO-B inhibitors to manage mild motor symptoms and delay the need for levodopa.

At the same time, more than half of surveyed primary care physicians say that it is "very likely" or "likely" they will increasingly use dopamine agonists and/or MAO-B inhibitors when initiating levodopa therapy in order to lower the dose of levodopa-carbidopa required.